A glimpse of Patientville 2001

One of the most frustrating things about being a member of a modernisation action team was being sworn to secrecy about our discussions until after the NHS plan was published. Even more frustrating was knowing we had no control whatsoever over what went into the plan - that was for ministers to decide. Nevertheless, it was a fascinating, challenging and surprisingly positive experience.

I attended the first meeting in April with a degree of cynicism bred from years of experience as the token patient/consumer on groups dominated by senior health professionals and managers, some of whom clearly thought it outlandish to share their discussions with such an outsider.

On this occasion it helped that the subject entrusted to my team - 'patient care: speed of access'- was one I knew a lot about from running the national waiting-list helpline, which has enabled many thousands of patients faced with unacceptable waits to see a consultant or be admitted to hospital.

At that first meeting at the Queen Elizabeth II conference centre opposite the Houses of Parliament, we were encouraged to be radical and free-thinking in our approach to drawing up a plan for the NHS in the new century, mindful that this would be a once-and-for-all opportunity. As HSJ bluntly put it on the day the plan was launched two weeks ago, 'patience is running out'.

After health secretary Alan Milburn's plenary exhortation to 'think the unthinkable', we split into six groups - each with its own minister - to agree our working method, which included a secret website for team members' eyes only:

we were urged to commit the address to memory (my first contribution was a list of the longest outpatient waiting times across the country, many well over a year and some a good deal longer).

Then came a brainstorm on the problems patients currently face in accessing the service, whether through accident and emergency, primary and community services or hospital waiting lists.

I was astonished to find myself, more than once, urging caution on recommendations for achievable targets on waiting times, whether to see a GP, for an outpatient appointment or to be admitted to hospital. The team, which included the president of a royal college, a cancer surgeon, GPs, professionals allied to medicine, a nurse who employs GPs in an inner-city personal medical services pilot, and trust chief executives, insisted tough targets could and should be met.

We also agreed early on that it would be vital for patients to have access to an advocate who could sort out problems before they became grounds for complaints and that, where unacceptable delays did occur, some mechanism should allow money to follow patients.

Time did not allow me to follow the other five deliberations in detail on the secret website. And none of us knew which - if any - of our recommendations would be taken up by ministers. So the final gathering at Richmond House, shortly after prime minister Tony Blair's announcement of the national plan to Parliament, was full of anxious expectation and an unprecedented hush as copies were handed out and the de-briefing began. Was it all worth it?

To help judge the plan, I dug out an issue of HSJ in which I had sketched my vision of a healthcare , Patientville 2001 ('Keeping the customer satisfied', 30 October 1997).That issue's editorial commented: 'Any minister who managed to improve the NHS's performance to that of Patientville in 2001. . . could expect to bask forever in the warm gratitude of the electorate, and claim with justification to have defeated that old assertion that all political careers end in failure.'

So are we headed in the right direction?

The massive extra resources - money, staff, hospitals, beds and primary care centres, none of which I had dared allow enter my Utopia - should help ensure morale is raised among staff as well as patients so they can begin re-engineering the service in an imaginative and humane way.

The patient advocacy service - which certainly shouldn't be restricted to hospitals - is much needed, and will be welcomed by all who find themselves lost in bureaucracy. The arrival of the 'modern matron' and an insistence on cleanliness on hospital wards and elsewhere will be equally welcomed, especially by older patients, who have sometimes despaired at the apparent lack of author ity or will to tackle such problems.

In Patientville 2001, local people were well-represented on health authority and trust boards and part of their remit was to carry out visits, including spot checks, to every part of the service, armed with checklists for observing and interviewing any of the patients and staff they encounter on the way.

This was done systematically, so every time the HA met it had a report on a different aspect of the local service and how well it was meeting local needs. This was so successful and popular with the public that local trusts followed suit.

And here we are in the real NHS, with 2001 yet to arrive, and 'a patients' forum will be established in every NHS trust and primary care trust to provide direct input from patients into how local NHS services are run. . . patients will have direct representation on every NHS trust board, elected by the patients' forum. . . (which), supported by the new patient advocate and liaison service, will have the right to visit and inspect any aspect of the trust's care at any time'.

When the consultation started, the College of Health and other patient organisations urged the government to make sure the NHS plan contained more than rhetoric about involving patients and carers in all the service's work. The door is now open. The challenge is to come together to make the new ideas work.

Financial penalties are being lifted from high-profile standards including cancer and elective waiting times, so far without attracting much attention. How is this happening? And will it work, asks Rob Findlay